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Improving Anemia in Inflammatory Bowel Disease: Impact of the Anemia Care Pathway

Abstract

Background

Anemia is a common complication of inflammatory bowel disease (IBD). Despite existing guidelines for anemia in IBD, it is frequently under-treated and the prevalence of anemia has remained high. To address this gap, the Crohn’s and Colitis Foundation developed the Anemia Care Pathway (ACP).

Aims

To implement the ACP in a managed care setting and identify where it improves practice habits and where barriers remain.

Methods

The ACP was implemented from July 2016 through June 2017 and retrospectively studied. Run charts were used to identify shifts in iron deficiency screening and treatment as well as anemia prevalence. Results were compared to those of other providers in the same center not using the ACP.

Results

640 IBD encounters were studied. In the ACP clinic (n = 213), anemics received iron therapy in only 30% of encounters at baseline but improved to 80%. Concurrently, anemia prevalence decreased from 48 to 25%. Screening for iron deficiency, however, did not improve. No shifts were seen in the non-ACP clinics (n = 427) across the same period despite awareness of the ACP and other guidelines.

Conclusions

Across 1 year, we observed gaps in the screening and treatment of anemia in IBD. Although screening rates did not improve, the ACP appeared to reduce missed opportunities for iron therapy by about half. Most importantly, this was associated with an overall decrease in anemia prevalence. Future refinements to the ACP should be focused on enhanced screening and follow-up.

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Funding

The research reported here was supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX (JKH).

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Authors and Affiliations

Authors

Contributions

JKH contributed to study design, data analysis, and authorship of manuscript. He has approved of the final draft submitted; TQ contributed to authorship, data analysis, and editorial input of the manuscript. He has approved of the final draft submitted; TPN contributed to authorship, data analysis, and editorial input in the manuscript. He has approved of the final draft submitted. RW contributed to editorial input in the manuscript. He has approved of the final draft submitted. DW contributed to editorial input in the manuscript. She has approved of the final draft submitted. RS contributed to editorial input in the manuscript. He has approved of the final draft submitted.

Corresponding author

Correspondence to Jason K. Hou.

Ethics declarations

Conflict of interest

JH has served as a speaker for Abbvie, Janssen, served as a consultant for Pfizer, Janssen, Daichii Sankyo, and Abbvie. JH has received research funding from Abbvie, Janssen, Pfizer, Celgene, Eli-Lilly, and Redhill Biopharma. TQ, TN, RW, DW, RS have no financial disclosures.

Ethical considerations

The institutional review boards of the Baylor College of Medicine and Michael E. DeBakey VA Medical Center in Houston, Texas, approved this study.

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Qureshi, T., Peter Nguyen, T., Wang, R. et al. Improving Anemia in Inflammatory Bowel Disease: Impact of the Anemia Care Pathway. Dig Dis Sci 64, 2124–2131 (2019). https://doi.org/10.1007/s10620-019-05559-w

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  • DOI: https://doi.org/10.1007/s10620-019-05559-w

Keywords

  • Anemia
  • Iron therapy
  • Iron deficiency
  • Inflammatory bowel disease
  • Anemia care pathway